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Supporting action on reducing health inequalities

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Aerial view of crowd connected by lines

Health inequalities in our society

In England today, those in the least deprived areas of the country live around 20 years longer in good health than those in the most deprived areas. This is just one example of the stark differences in health outcomes that exist between different groups and communities in our society.

Health inequalities are systematic, avoidable and unjust. They arise because of the conditions in which we are born, grow, live, work and age, which influence our opportunities for good health and how we think, feel and act. This then shapes our mental health, physical health and wellbeing.

The COVID-19 pandemic has not only brought existing health inequalities into sharp focus, but in some cases, has increased them, through its disproportionate impact on certain population groups. This was clearly demonstrated in PHE’s recent COVID-19 review of disparities in risks and outcomes.

PHE recognises the vital importance of going beyond considering health inequalities in the abstract, instead imbedding consideration of these inequalities at every level of our work. The wide-reaching impact of COVID-19 has rendered this commitment to reducing inequalities more important than ever.

The Health Equity Assessment Tool (HEAT)

PHE has launched the Health Equity Assessment Tool (HEAT) – a framework consisting of a series of questions and prompts, designed to support professionals across the public health system and wider health economy systematically address health inequalities and equity in their work programmes, services or business planning cycles.

Screenshot of the Health Equity Assessment Tool

The HEAT provides an easy-to-follow template which can be applied flexibly to suit different work programmes. It has 4 clear stages:

  1. Prepare
  2. Assess
  3. Refine and Apply
  4. Review

The tool can be accessed in a full or simplified format, allowing flexibility for different users. It forms part of a suite of resources, including an interactive e-learning module developed in partnership with Health Education England, and a collection of practice examples demonstrating the benefits of applying HEAT in a number of work programmes or services.

The creation of the HEAT, by PHE’s national Health Inequalities team, was driven by requests from across the system for a robust yet practical and user-friendly assessment that could be used by a range of stakeholders. Its aim is to support action on health inequalities and generate improvements, not only locally but also at a regional and national level.

PHE has also recently developed the Health Equity Audit Guide for Screening Providers and Commissioners. This guidance is designed to be used in conjunction with the full HEAT, but has been tailored to be more specific to issues relevant to screening services.

Practical application of HEAT

Use of HEAT is already making an impact across the country. For example, it was recently applied to Sheffield City Region Weight Loss Management Services. The onset of COVID-19 and social distancing requirements led to significant changes to the delivery of these vital services. HEAT was used to systematically assess the effect of these changes, how any impacts might be disproportionately distributed, and how best to mitigate any negative impacts.

Similarly, HEAT was applied in national antimicrobial resistance (AMR) campaigns. It helped colleagues identify groups who might be unable to access or understand AMR resources, and design a communication process and messaging with a focus towards specific populations. As a result of using HEAT, tackling health inequalities has become firmly embedded in the national AMR programme, contributing to the overall UK AMR national action plan.

We want HEAT to become a key resource for people across the public health system, wider health economy and local authorities, to enable comprehensive assessment of health inequalities within all programmes of work. We hope that in doing so, HEAT will complement the brilliant work already taking place across the country and ultimately, reduce health inequalities and improve lives.

We would welcome your feedback and thoughts on the HEAT, as well as case studies of its application - please send these to

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